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Merchant Name *

Full Name

Target Vertical(s) *

Target Market(s) (List ALL countries desired) *

Country where the Merchant is domiciled/located *

Licenses they have (if any) *

Settlement currency type (FIAT or Crypto or Both) *

Nationality of the Authorized Signatory *

Payment method(s) requested (PAY-IN) *

If Credit Cards, are Merchants Whitelisting or seeking FTD (First Time Deposit)? *

Is a PAY-OUT (Disbursement) solution required? *

Minimum transaction amount

Maximum transaction amount

Current Total Monthly Volume *

Forecasted Monthly Volume in 6 Months *

URL Address(es) *

Email *

Phone *

Payjeezy Agent Name

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